4645 Beacon Hill Rd - Inspection Form411110
City Di tarp
Residential Sanitary Sewer Service
Compliance Inspection
• 7' am
Dated__ = t Time _ D ' o pm
Name ,/
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drai connection
O No roof drain con ection
O Sump pit not conn ted to
sanitary sewer
O Sump pump proper piped
O No sump pump
Service Lateral 1 nsp c tion Findings
Roots
Poor Pipe Jots
Mineral \ Deposits
Sag /Pipe ' eflection
Damaged pipe
Transition
4" to 6" Transition:
Disk#
Ovjndr /Occupant Signature
White Copy: Property Owner
� f
Street Name )
Non - Compliance
O Clear water connections,to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks
MINN
Length of Ser vice:
Yellow Copy: City of Fagan
P a
Record Number
Time
1 ! y - —
Phone ff
Obstruction
Unable to push past
feet
O am
•
• O pm
Inspector Signature
1 f ,
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L.at
Pink Copy: SEH
Number Discharged
N otes
) r r
Pk"" , a — - / ' ' c '
_
r --.n, - �„..
Total
Correctly
orrectly Unknown
Sump pumps
Foundation drains
Roof drains
411110
City Di tarp
Residential Sanitary Sewer Service
Compliance Inspection
• 7' am
Dated__ = t Time _ D ' o pm
Name ,/
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drai connection
O No roof drain con ection
O Sump pit not conn ted to
sanitary sewer
O Sump pump proper piped
O No sump pump
Service Lateral 1 nsp c tion Findings
Roots
Poor Pipe Jots
Mineral \ Deposits
Sag /Pipe ' eflection
Damaged pipe
Transition
4" to 6" Transition:
Disk#
Ovjndr /Occupant Signature
White Copy: Property Owner
� f
Street Name )
Non - Compliance
O Clear water connections,to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks
MINN
Length of Ser vice:
Yellow Copy: City of Fagan
P a
Record Number
Time
1 ! y - —
Phone ff
Obstruction
Unable to push past
feet
O am
•
• O pm
Inspector Signature
1 f ,
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L.at
Pink Copy: SEH
41111 City of Fa
Residential Sanitary Sewer Service
Compliance Inspection
Date / /�. / /f
Name -/
House Number
• .'
Time. • p
Disk #
PID Number
- ,. Street Name
Record Number
; i
)
Alternative Mailing Address Phone;
Owner /Occupant Signature
Compliance
O No foundation drain connection
No roof drain connection
Surnp pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
ti
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Fagan
" . O am
• -4 Time p
inspector Signature
Number of stacks Entered S,L at - ' ..:�%
Obstruction
Unable to push past
feet
"7, 7") -.7 7
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
%
Final Cleanout: •
r� rf l
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes , z -
_r j 3 ` �1 -! " j �
Ii I CAA°' p / I
` -',,z, 't 7 ,�_,,
Total
Sump pumps
7 r �% ^f
Foundation drains
� _
Roof drains
1,,'
1M
41111 City of Fa
Residential Sanitary Sewer Service
Compliance Inspection
Date / /�. / /f
Name -/
House Number
• .'
Time. • p
Disk #
PID Number
- ,. Street Name
Record Number
; i
)
Alternative Mailing Address Phone;
Owner /Occupant Signature
Compliance
O No foundation drain connection
No roof drain connection
Surnp pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
ti
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Fagan
" . O am
• -4 Time p
inspector Signature
Number of stacks Entered S,L at - ' ..:�%
Obstruction
Unable to push past
feet
"7, 7") -.7 7
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
%
Final Cleanout: •
r� rf l
Pink Copy: SEH